Nomination Form

3, avenue de Miremont CH 1206 Geneva Tel: +41 22 704 1820 Fax: +41 22 704 1821 secretariat@internationalpublishers.org

THE 2012 IPA FREEDOM TO PUBLISH PRIZE

The IPA Freedom to Publish Prize for exemplary courage in upholding freedom of expression and freedom to publish. 1. Nominating address): Person/Organisation, including contact details (e-mail, tel,

2. Nominee, including contact details (e-mail, tel, address):

3. Biographical Note*:

4. How has the nominee contributed to the defence and promotion of freedom to publish*?

5. Date: 6. Signature:

TO BE RETURNED TO ALEXIS KRIKORIAN krikorian@internationalpublishers.org Fax: + 41 22 704 1821 BEFORE 4 MAY 2012
*

Should you need more space for items 3 and 4, you may use separate annexes.

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